Regional estimates of stomach cancer burden in Italy

AIMS AND BACKGROUND: Stomach cancer still remains one of the most frequent tumors in Italy and Europe. The aim of this paper is to present estimates for stomach cancer mortality, incidence and prevalence over the period 1970-2010 for the Italian regions and for Italy as a whole. METHODS: Estimated figures for incidence, prevalence and mortality were obtained by using the MIAMOD method. Starting from the knowledge of mortality in the period 1970-1999 and of relative survival in the period of diagnosis 1978-1994, we derived incidence and prevalence estimates and projections up to the year 2010 by means of a statistical back-calculation approach. Survival at the regional and national levels was modelled on the basis of published survival data from the Italian cancer registries. RESULTS: Incidence and mortality trends for both sexes decrease by about 60% during the estimation period 1970-2010. Both indicators show a 2-fold male/female ratio all over the country, and a similar gender time trend. The incidence and mortality in the North and Center of the country are estimated to be higher and to decrease more steeply than those in the South, both for men and women. A total of around 13,000 incident cases, 57,000 prevalent cases, and 8,000 deaths are estimated to have occurred in Italy in 2005. CONCLUSIONS: The incidence and mortality trends are estimated to decline during the entire period 1970-2010, with different slopes between northern-central and southern regions.The incidence and mortality are quite similar among Italian regions, showing that the risk of developing the disease diminishes and is becoming more homogeneous than in the past decades all over the country.     

Regional estimates of all cancer malignancies in Italy

AIMS AND BACKGROUND: The aim of this paper is to present regional and national estimates of mortality, incidence and prevalence for all cancers in Italy over the period 1970-1999, with projections up to 2010. METHODS: The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach, to derive incidence and prevalence starting from mortality and relative survival data. Published data from the Italian Cancer Registries were modeled in order to estimate regional and national cancer survival. RESULTS: Cancer time trends resulted more favorable in northern-central regions than in southern regions, both for men and women. Mortality started to decrease in the northern-central area approximately from the mid 1980s, whereas it was expected to slightly decline only after the year 2000 in the southern area. Incidence was estimated to decrease in men from 1995 in northern and central areas only; no incidence reduction is expected for women during the study period. Overall, 130,000 cancer deaths, 250,000 new cancer cases and 1,700,000 prevalent cancer cases are estimated in Italy in the year 2005. CONCLUSIONS: This up-to-date picture of cancer risk and burden in the Italian regions shows as a relevant epidemiological change is ongoing in Italy. Although a clear geographical variability in mortality and morbidity levels still exists across the country, the historical North-to-South gap appears smaller than in the past. This change is particularly remarkable for men, as a consequence of trends that are favorable in northern-central regions but not yet in southern regions.     

Regional estimates of breast cancer burden in Italy

AIMS AND BACKGROUND: Breast cancer is the most common cancer and the leading cause of cancer death among women. Knowledge of the present and future burden of the disease at a regional and national scale is a major issue in Italy, where the frequency and coverage of screening programs vary considerably across the country. This study presents estimates and projections of the female breast cancer incidence, prevalence and mortality for Italy and all Italian regions in the period 1970-2010. METHODS: The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures from mortality and relative survival data. Published data from the Italian cancer registries were modelled to obtain regional and national estimates of breast cancer survival. RESULTS: Breast cancer mortality has been declining from the late 1980s in the northern-central regions and from the mid 1990s in the southern regions Puglia, Sicilia and Sardegna. Stable mortality rates are estimated for the other southern regions in the 2000's first decade. The incidence rate in Italy is estimated as increasing until the late 1990s, and stable thereafter (93 per 100,000). The incidence curve is also estimated to flatten in many northern-central regions from the late 1990s or later. Rising incidence trends are estimated in all southern regions, with the exception of Puglia. About 8,500 deaths, 37,000 new diagnoses and 416,000 prevalent cases for breast cancer are estimated among Italian women in 2005. In the same year, the proportion of prevalent cases in the northern area (1221 per 100,000) is about twice that estimated in the South (685 per 100,000). DISCUSSION: The geographical variation in female breast cancer burden can be explained by the unequal distribution of screening. A more widespread screening activity in the southern regions would help to bridge the gap between northern-central and southern regions. Continuous monitoring of regional epidemiological indicators for breast cancer is crucial to evaluate the effect of different health measures taken to control breast cancer in Italy.     

Regional estimates of colorectal cancer burden in Italy

AIMS AND BACKGROUND: In terms of new diagnoses, colorectal cancer is one of the most important cancers in Italy and worldwide.The aim of this paper is to present estimates of the mortality, incidence and prevalence of colorectal cancer in Italy at a national and regional scale over the period 1970-1999, with projections up to 2010. METHODS: The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence estimates from mortality and relative survival data. Published data from the Italian cancer registries were modelled to obtain regional and national estimates of colorectal cancer survival. RESULTS: Different incidence patterns were observed for men and women, especially in the projection period: the national age-standardized rate is estimated to increase throughout the study period 1970-2010 for men from 30 to 70 per 100,000, and to stabilize from the end of the 1990s for women at around 38 per 100,000. A stabilization or a slight decrease in age-standardized incidence rates is expected in most regions for women and in most northern-central regions for men. The most critical situation is estimated among men for southern regions, where the rise in incidence is accompanied by a dramatic increase in mortality. About 46,000 incident cases, 267,000 prevalent cases, and 16,000 deaths from colorectal cancer are estimated in Italy for the year 2005. CONCLUSIONS: Despite the risk reduction estimated in most northern-central regions among men and in the large majority of regions among women, the colorectal cancer burden in Italy is expected to remain relevant in the next years. Prospects for reducing this burden appear mainly connected to the adoption of prevention policies aimed at increasing the awareness of the risk related to dietary habits and lifestyles and at promoting colorectal cancer screening.     

Regional estimates of prostate cancer burden in Italy

AIMS AND BACKGROUND: Prostate cancer is one of the most common cancers in developed countries and the most common among men in industrialized countries.The introduction of new diagnostic procedures caused an increase in new diagnoses in Italy starting from the early 1990s, while the prognosis of prostate cancer improved due to the use of hormonal treatments. The aim of this paper is to present estimates of prostate cancer mortality, incidence and prevalence over the period 1970-2005 for the Italian regions and for Italy as a whole, and to assess the changes that opportunistic screening and the diffusion of more effective treatments introduced. METHODS: Estimated figures for incidence, prevalence and mortality were obtained with the MIAMOD method. Starting from the knowledge of mortality in the period 1970-1999 and of the relative survival in the period of diagnosis 1978-1994, we derived incidence and prevalence estimates up to the year 2005 by means of a statistical back-calculation approach. Survival at regional and national levels was modelled on the basis of published survival data from the Italian cancer registries. RESULTS: The incidence trend showed a steep increase all over the country during the entire estimation period 1970-2005 with a more pronounced increase in the Center-North then in the South of Italy. Incidence of northern and central regions was about twice as high as that of southern regions. Mortality trends were however constant or declining in the majority of northern-central regions, while they still increased in the South. A total of around 43,000 incident cases, 174,000 prevalent cases and 9,000 deaths were estimated for Italy in 2005. DISCUSSION: The effects of opportunistic screening are reflected in an earlier diagnosis for many patients. The existing North-South gradient in incidence seems to be associated with the different spread of the PSA test in different parts of the country. Prostate cancer remains a great health problem in terms of both incidence and prevalence.     

Estimating regional cancer burden in countries with partial registration coverage: an application to all malignant neoplasms in Italy over the period 1970-2010

Regional epidemiological indicators of cancer burden are essential information for cancer surveillance and health resources planning, especially in countries with partial registration coverage and geographically variable risk patterns, such as Italy.This paper presents a methodology to derive cancer incidence and prevalence at the regional and national scale and illustrates its application to all malignant neoplasms in Italy for the period 1970–2010.The method, denoted as MIAMOD, is based on a back-calculation approach and derives cancer-specific morbidity measures by using official mortality data and model-based relative survival from local Cancer Registries data. The output includes time-trends and projections of a complete set of epidemiological indicators, i.e. mortality, incidence and prevalence.Results for all cancers in Italy show different incidence patterns by gender and a pronounced regional variability among men: male incidence is estimated to decrease in almost all northern-central regions, while more stable or even rising trends are estimated in the southern regions. No incidence reduction is expected for women. Prevalence increases country-wide in both sexes.The proposed approach can be applied to derive regional up-to-date time trends of cancer burden indicators in countries with local and sparse cancer registration systems. These estimates are useful for planning health services on a national and regional basis and for highlighting regional differences.     

National estimates of cancer patients survival in Italy: a model-based method

AIMS AND BACKGROUND: To provide model-based estimates of all cancers patient survival in Italy and in Italian large geographical areas (North-West, North-East, Center, South), where only partial coverage of cancer registries data is available, and to describe them in terms of time trends. Moreover, to measure the degree of representativeness of cancer patient survival obtained from Italian cancer registries data. METHODS: Relative survival in the four main Italian geographical areas was estimated by a parametric mixture model belonging to the class of "cure" survival models. Data used are from Italian cancer registries, stratified by sex, period of diagnosis and age. The Italian national survival was obtained as a weighted average of these area-specific estimates, with weights proportional to the number of estimated incident cases in every area. The model takes into account also differences in survival temporal trends between the areas. RESULTS: Relative survival for all cancers combined in Italian patients diagnosed in 1990-1994 was estimated to be higher in women (53%) than in men (38%) at 5 years from the diagnosis. The survival trend is increasing by period and decreasing by age, both for men and women. The greatest gain in terms of survival was obtained by the elderly, with annual mean growth rates in the period 1978-1994 equal to 3.5% and 3.2% for men and women, respectively. More than 50% of the youngest cancer patients were "cured", whereas for the elderly this proportion dropped to 15% and 25% for men and women, respectively. The South of Italy had the lowest survival and the North the most pronounced increase. CONCLUSIONS: The obtained national survival estimates are similar, but not identical, to previously published estimates, in which Italian registries' data were pooled without any adjustment for geographical representativeness. The four Italian areas have different survival levels and trends, showing variability within the country. The differences in survival between men and women may be explained by the different proportion of lethal cancers. Among males, most cases had a poor prognosis (lung and stomach cancers), whereas among females the largest proportion was made up of curable and less lethal cancers (breast cancer).     

Italian cancer burden by broad geographical area

AIMS AND BACKGROUND: Cancer burden estimates in Italian regions are available for the period 1970-2010 as a result of the project "I TUMORI IN ITALIA" connected with EUROCHIP, the European project on cancer control. The Italian health-care system is organized at a regional level, so regional estimates of cancer indicators are useful to identify priorities for cancer plans. We compared cancer site-specific epidemiological estimates by 3 macro-areas (obtained by grouping regions) to suggest priorities for Italian cancer control plans, both at national and regional levels. METHODS: Mortality and incidence estimates for all cancers combined and for stomach, colorectal, lung, breast and prostate cancers were downloaded from the website www.tumori.net and aggregated in broad age classes (0-54, 55-74 and 75-84 years) and macro-areas (northern, central and southern Italy). RESULTS: Historically, Southern Italy had a lower cancer risk than the Center and North. After 2000 this epidemiological picture disappeared and the incidence and mortality rates in the Center are reaching those of the North. Also the weight of various cancer sites on all cancers has changed in Italy in the last decades. Lung cancer is still the most frequent cancer in the male population in the South, while in the Center-North it has been surpassed by prostate cancer and colorectal cancer. The lung cancer weight on all cancer deaths is increasing in women. Prostate cancer has become the most frequent male cancer in the Center-North in the age class 55-84. Breast cancer is the most frequent cancer in the female population and its incidence rates in the North are higher than those in the Center-South for all age classes. Colorectal cancer incidence rates have dramatically increased in men and colorectal cancer is nowadays the second cancer diagnosed in women in all age classes and macro-areas. DISCUSSION: From the epidemiological data here presented we derived the following suggestions and observations for cancer control plans: (a) tobacco prevention should focus on the male population in the South, and on female populations in the country as a whole; (b) prevention concerning diet and physical activity (risk factors for colorectal cancer) should be considered mainly for men at a national level; (c) the coverage of breast cancer screening programs should be increased in the Center-South; (d) colorectal cancer screening should be promoted at a national level; (e) PSA testing (that is not actually included among the screening programs recommended) for prostate cancer is probably more widespread in the Center-North, resulting in an increased incidence without any evident decline in mortality as yet.     

Cancer prevalence in Italian regions with local cancer registries

OBJECTIVE: To provide estimates and projections of cancer incidence and prevalence for those Italian regions whose population is partially covered by a cancer registry (CR) and to determine to what extent local CRs can be considered representative of the region, thus improving the potential of the information provided by CRs. METHODS: A statistical method, MIAMOD (mortality-incidence analysis model), was used to estimate regional cancer incidence and prevalence from regional cancer mortality data and patient survival data recorded by the cancer registries. Estimates of the cancer incidence and prevalence in the various regions have thus been obtained for a number of major cancer sitas. A first and important step in validating the regional estimates has been the comparison of the MIAMOD estimates in the areas covered by the cancer registries with empirical incidence and prevalence observed by CRs, in order to assess the consistency in data, methods and assumptions. Empirical prevalence has been calculated by counting patients with a diagnosis of cancer who were alive on the reference date by PREVAL method. A correction factor has been applied to include patients diagnosed before the period of activity of the registry. RESULTS: General consistency was found between empirical and estimated (by MIAMOD) incidence and prevalence in the registry areas, which is indicative of the quality and the completeness of all data involved as well as the appropriateness of model choices. The prevalence of all cancers combined for Italian regions with CRs was estimated and projected to the year 2000 as ranging between 1,240 per 100,000 in Sicilia and 2,781 in Emilia-Romagna for men, while for women these figures were 1,765 in Sicilia and 4,019 in Liguria. Comparison of cancer prevalence in CR areas with regional estimates shows quite good consistency for Piemonte, Liguria and Lombardia, which means that the local CRs (of Torino, Genova and Varese, respectively) are representative of their respective regions. Prevalence in Emilia-Romagna appears to be rather well represented by only one, the Parma CR, of the three local CRs. The southern Italian registries of Latina and Ragusa recorded a lower cancer prevalence than was actually estimated in their respective regions. DISCUSSION: Cancer registries with a longer period of activity showed better agreement between empirical and estimated figures due to the more precise information provided, particularly regarding survival and incidence trends. In conclusion, this work shows the potential of the cancer registries not only to represent their population with respect to cancer morbidity but also as an invaluable tool to extrapolate this information to the larger areas they represent.     

Cancer prevalence estimates in Italy from 1970 to 2010

AIMS AND BACKGROUND: The growing number of cancer survivors in Italy is expected to continue to increase as a consequence of population aging and survival improvements, but few estimates are currently available, particularly on the national and regional scale. The purpose of this work is to present detailed and updated prevalence estimates in Italy over the period 1970-2010 by cancer site (all cancers combined, stomach, colon and rectum, lung, breast and prostate) and gender. METHODS: Prevalence was derived with the MIAMOD statistical method, using cancer-specific mortality and relative survival as input data. Survival data from the Italian cancer registries were modeled to derive a national estimate for each cancer site and sex. To estimate prevalence trends, survival was assumed to improve in the future with the same rate observed in the period 1978-1994. A double scenario for survival--increasing or stationary--was considered to decompose the prevalence growth from 1995 to 2005 by its determinants: demographic changes, incidence and survival dynamics. The prevalence estimates were also decomposed by disease duration (2, 5 and 10 years) and by age (0-44, 45-59, 60-74 and 75-99). RESULTS: The proportion of cancer survivors in 2010 is expected to be about 4% in women and 3% in men, about twice the values attained in 1990. The highest dynamics was observed for prostate cancer, with a three-fold increase just in the 1995-2005 period (from 212 to 623 per 100,000), whereas in absolute terms breast cancer presented the highest levels (1700 per 100,000 in 2010). The overall number of cancer prevalent cases is expected to rise by about 48% in the decennium 1995-2005 (from 1,152,000 to 1,709,000), and this growth is mainly attributable to incidence dynamics (+21%), then to survival improvements (+14%) and population aging (13%). In 2005, the 2-year prevalent cases were estimated to be 20% of all cancer survivors, 21% between 2 and 5 years from the diagnosis, 23% between 5 and 10 years, with 36% surviving for more than 10 years. Prevalence proportion was very high in the elderly (12.6% for 75-84 years and 8% for 60-74 years). CONCLUSIONS: Updated prevalence data with appropriate coverage of the national territory are essential to define priorities in health care management and to develop cancer control programs. Prevalence by disease duration and by age should be the basis for planning research on the quality of life of cancer survivors, as long as cancer continues to become an even more chronic disease.     

Incidence and mortality trends for four major cancers in the elderly and middle-aged adults: An international comparison

BackgroundTime trends comparisons by age are important to understand the specific needs of elderly cancer patients and to improve clinical procedures. The aim is to compare 1998–2005 cancer incidence and mortality trends in Italy and the US for both sexes and for two age groups, namely 50–69 year old and 70+ year old.MethodsCancer incidence and mortality data came from 22 Cancer Registries (CRs) of the Italian association of cancer registries (AIRTUM), while the US incidence records were provided by 13 SEER CRs and the mortality statistics provided by the WHO Database. Trends were analysed by the Joinpoint Regression Program in order to obtain Annual Percent Changes and Joinpoints.ResultsColorectal cancer incidence trends were favourable in the US for both sexes and in both age groups, whilst the rates increased in Italian elderly individuals and mortality rates fell markedly only in the US. For lung cancer, incidence and mortality decreased in men but increased in women in the two geographical areas. Breast cancer incidence and mortality declined both in Italy and the US for younger women, but the trends were less favourable in the Italian elderly individuals. The increase of prostate incidence slowed down and mortality diminished for every age group in the US, whilst in Italy only in the younger group.ConclusionsFor major cancers, the Italian elderly experienced less favourable trends than the middle-aged patients whereas, in the US, the trends were similar for both age groups and favourable also for the elderly.     

Cancer incidence and mortality in Portugal

In this paper, we present estimates of national cancer incidence in Portugal in 1996-1998, predictions for the year 2000, and interpret the recent cancer mortality trends in light of observations from epidemiological research and risk factor patterns. In Portugal, national mortality data from vital statistics are available from 1960, while cancer registration has been mandatory since 1988, when three regional cancer registries covering the mainland of the Portuguese Republic were set up. Up until now, however, none of these registries has been able to produce data with an acceptable completeness of registration--hence this study. Mortality data from Portugal for 1996-1998 and incidence data for 1990-1995 from Vila Nova de Gaia (RVNG) (the most complete of the Portuguese cancer registries), 14 Italian registries and nine Spanish registries were assembled to produce the best possible estimates of numbers of incident cases for each age group and gender. A total of 19,880 new cancer cases are estimated to have been diagnosed among men in the year 2000, and nearly 17,000 new cancer cases in women. The most common cancer among Portuguese men in 2000 is cancer of the colorectum (3173 new cases), followed by cancers of the prostate (2973), lung (2611), stomach (2206) and urinary bladder (1360). In women, breast cancer is the most common cancer (4358) followed by cancers of the colorectum (2541), stomach (1494) and corpus uteri (1083). The overall age-standardised cancer mortality rate for men in Portugal increased steeply (1.4% annually) during the period 1988-1998, with prostate cancer (3.6% annually), colon and rectum (3.3%) and lung (2.4%) mostly contributing. Among women, the overall cancer mortality rate was stable (a non-significant decrease of approximately 0.2% per year). These remarkable results, particularly in males, demonstrate the need for a comprehensive national programme against cancer. Since the increasing epidemic of lung cancer (in men), as well as other tobacco-related cancers, is observed in Portugal, the important component of such a programme should be a nationwide tobacco control programme. Improving accessibility to highly effective diagnostic and treatment procedures for cancer in general and colorectal and prostatic cancers in particular should be a priority in the fight against cancer.     

Cancer prevalence in Italy: an analysis of geographic variability

Purpose

Statistics on cancer prevalence are scanty. The objectives of this study were to describe the cancer prevalence in Italy and to explore determinants of geographic heterogeneity.

Methods

The study included data from 23 population-based cancer registries, including one-third of the Italian population. Five-year cancer prevalence was observed, and complete prevalence (i.e., all patients living after a cancer diagnosis) was estimated through sex-, age-, cancer site-, and observation period length-specific completeness indices by means of regression models.

Results

In 2006, 3.8?% of men and 4.6?% of women in Italy were alive after a cancer diagnosis, with a 5-year prevalence of 1.9 % and 1.7?% in men and women, respectively. A relevant geographic variability emerged for all major cancer sites. When compared to national pooled estimates, crude cancer prevalence proportions were 10?% higher in the north and 30?% lower in the south of Italy. However, these variations were consistently reduced after age adjustment and, in both sexes, largely overlapped those of incidence rates, with correlations >0.90 between variations of prevalence and incidence for all cancer sites and areas.

Conclusions

Magnitude of the cancer prevalence and the geographic heterogeneity herein outlined in Italy will help in meeting the needs of specific population of survivor patients.     

Cancer prevalence in United States,Nordic Countries,Italy, Australia,and France: an analysis of geographic variability

Background:

The objectives of this study were to quantitatively assess the geographic heterogeneity of cancer prevalence in selected Western Countries and to explore the associations between its determinants.

Methods:

For 20 cancer sites, 5-year cancer prevalence, incidence, and survival were observed and age standardised for the mid 2000s in the United States, Nordic European Countries, Italy, Australia, and France.

Results:

In Italy, 5-year crude prevalence for all cancers was 1.9% in men and 1.7% in women, while it was ∼1.5% in all other countries and sexes. After adjustment for the different age distribution of the populations, cancer prevalence in the United States was higher (20% in men and 10% in women) than elsewhere. For all cancers combined, the geographic heterogeneities were limited, though relevant for specific cancers (e.g., prostate, showing >30% higher prevalence in the United States, or lung, showing >50% higher prevalence in USA women than in other countries). For all countries, the correlations between differences of prevalence and differences of incidence were >0.9, while prevalence and survival were less consistently correlated.

Conclusion:

Geographic differences and magnitude of crude cancer prevalence were more strongly associated with incidence rates, influenced by population ageing, than with survival rates. These estimates will be helpful in allocating appropriate resources.     

The changing epidemiology of lung cancer in Europe

BACKGROUND: Since the incidence and mortality of the histological subtypes of lung cancer in Europe has changed dramatically during the 20th century, we described the variation and changes in incidence, treatment modalities and survival of lung cancer. METHODS: For geographical variation and changes in incidence, data of the European cancer incidence and mortality (EUROCIM) database were used, and data on survival were derived from the EUROCARE database. For trends in treatment modalities and survival, according to histology and stage, data of the Eindhoven Cancer registry were used. RESULTS: Although the incidence of lung cancer among men in Denmark, Finland, Germany (Saarland), Italy (Varese), the Netherlands, Switzerland and the United Kingdom has been decreasing since the 1980s, the age-adjusted rate for men in other European countries increased at least until the 1990s. Among women the peak in incidence had not been reached in the 1990s. The proportion of adenocarcinoma has been increasing over time; the most likely explanation is the shift to low-tar filter cigarettes. In the 1990s more patients with localised non-small cell lung cancer received surgery than in the 1970s. Among patients with non-localised non-small cell lung cancer and among those with small cell lung cancer there was a trend towards more chemotherapy. There was fairly large variation in survival within Europe. Despite improvement in both the diagnosis and treatment, the overall prognosis for patients with non-small-cell lung cancer hardly improved over time. In contrast, the introduction and improvement of chemotherapy since the 1970s gave rise to an improvement in survival for patients with small-cell lung cancer. CONCLUSION: The epidemic of lung cancer is not over yet, especially in southern and eastern Europe. Prevention remains the best policy, but improvement in the management of lung cancer also remains very important.     

Observations on the effect of abolishing analgesic abuse and reducing smoking on cancers of the kidney and bladder in New South Wales, Australia, 1972–1995

Objectives: We have assessed the effect on the rates of cancers of the kidney and bladder of measures undertaken by the government in 1979–1983 to limit smoking and analgesic abuse in New South Wales (NSW). Sale of phenacetin-containing analgesics, previously available without restriction and regularly taken by 11–13% of women and 4–9% of men in NSW, was prohibited from 1979. The prevalence of current smokers among adult Australian men had fallen from 72% in 1945 to 43% in 1980 and to 28% in 1992. In women the corresponding figures were 26%, 31% and 24%.Methods: Incidence and mortality data from the New South Wales Central Cancer Registry for the period 1972 to 1995 were analyzed, by sex and age, for trends over time. Relative survival was calculated for cases diagnosed in the period 1980–94 and followed until the end of 1996.Results: Significant trends evident from these data were: throughout the period of review a rising incidence of, and to a lesser extent mortality from, renal parenchymal cancer for which relative survival has steadily improved; falling mortality from bladder cancer throughout the period of review, but more rapid after 1985; a reversal of the earlier increasing incidence of, and mortality from, cancer of the renal pelvis; and relative survival for bladder and renal pelvic cancers which was worse in women than men. Changes in registration practice in 1985 and 1993 introduced artifacts into the trends in incidence of bladder cancer.Conclusions: Improvements in the trends of incidence and mortality of cancers of the renal pelvis and bladder in the mid-1980s are interpreted, in the light of registration and clinical practice, to indicate a beneficial effect of regulations which virtually abolished analgesic abuse and, less certainly, a contribution from measures restricting smoking, in New South Wales. However, renal parenchymal cancer continues to increase, although there has been some apparent benefit of earlier detection.     

Evaluation of recent trends in cancer mortality and incidence among blacks

Recent trends in the cancer incidence, mortality, and 5-year survival rate for the black population were evaluated using the available national data up to 1981. Blacks have the highest overall age-adjusted cancer rates in both incidence and mortality of any US population group. The overall cancer incidence rates for blacks rose 17%, while for whites it increased 13% from 1969 to 1981. The rate in black men has increased 22.9%, while the rate in black women has increased 13.1%. The overall increase is the result of increases in cancers of the lung, prostate, colon-rectum, and esophagus. The age-specific incidence of lung cancer reflects the decrease of its incidence in those between 20 and 40 years of age because of the change in smoking habits after the Surgeon General's report on smoking. The overall cancer mortality rates for blacks increased 39% during the period. Lung cancer had the highest mortality rate, having increased more than 77.8% since 1969. This trend greatly reflects the recent increase in lung cancer incidence among black women. The overall 5-year cancer survival pattern for blacks was almost unchanged from 1973 to 1981, while whites had slightly higher survival rates during this period. However, blacks had substantial increases in survival rates for cancers of the esophagus and bladder during the period.     

Breast cancer incidence and prevalence estimated from survival and mortality

Survival probability for female breast cancer patients was used to estimate incidence rates from breast cancer mortality data in Italy. The female breast cancer survival curve from the Lombardy Cancer Registry (LCR) was used to test the method on data from four local cancer registries, covering areas in different regions of Italy. In spite of the well known geographic variability of female breast cancer incidence and mortality, the results support the idea that survival probability does not change across the country and that the survival probability from the LCR is a good estimate of that in the country as a whole. Female breast cancer incidence and prevalence rates were then estimated for Italy, making use of a mathematical model specifically developed for chronic diseases. In 1985, crude incidence and prevalence rates of female breast cancer, for ages up to 74 years, were estimated as 71 and 701 per 100,000 women, respectively. Estimated incidence rates show a complex trend with age, increasing to a temporary pronounced peak at the age of 52. A marked cohort effect was found to increase significantly the risk of the disease from the 1886 to the 1930 birth cohorts by a factor of 2.9. After the 1930 cohort, risks have continued at a constant high level.Drs Capocaccia and Verdecchia are with the Department of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy. Drs Micheli, Sant, Gatta, and Berrino are with the Lombardy Cancer Registry, Istituto Nazionale dei Tumori, Milan, Italy. Reprint requests should be addressed to Dr Capocaccia at Viale Regina Elena 299, Rome, Italy.